WIN a
copy of NCLEX-RN Review made Incredibly Easy!,3rd
edition, a $39.95 value. You must be an ANS eNews
subscriber to be eligible, so join now. The winner will
be randomly selected from among ANS eNews subscribers
on December 20, 2006 and announced
here in the January issue.

Welcome to the Nursing2006American Nursing Student (ANS) eNews, brought to
you by the editors of Nursing2006 in conjunction
with NursingCenter.com--absolutely .
Written especially for nursing students, it includes
practice NCLEX questions, medication errors to avoid,
tips on how to care for dying patients, advice from
experienced nurses, and much more.

You're getting this issue because you subscribed to
Nursing2006 ANS eNews--or because you indicated
in your NursingCenter registration profile that you're
a nursing student. If you want to continue getting this
monthly eNews, please update your NursingCenter profile
(just select the Nursing2006 American Nursing Student
eNews checkbox) or join now to become a member
of NursingCenter.

It's .
But you must register at NursingCenter and select Nursing2006
ANS eNews, to get future issues.

FDA
Alert: The FDA has received
reports of death and life-threatening adverse
reactions in patients taking methadone, which
can cause slow or shallow breathing and dangerous
changes in heart rate that the patient may
not feel. Pain relief from a dose of methadone
lasts about 4 to 8 hours, but it stays in
the body much longer—from 8 to 59 hours after
it's taken. So patients may feel the need
for more pain relief before methadone is gone
from their body. Methadone may build up in
the body to a toxic level if it's taken too
often, if the amount taken is too high, or
if it's taken with certain other medicines
or supplements. Read this alert to learn what
to teach your patient taking methadone.

New
recall: Complete MoisturePLUS
Contact Lens Care Products. There's a nationwide
recall of 18 lots of Complete MoisturePLUS
multipurpose contact lens care solution and
Active Packs distributed in the United States.
Certain lots were found to have bacterial
contamination. Contact lens users who have
the recalled product should discontinue use
immediately. Individuals who experience symptoms
of an eye infection, such as redness, pain,
tearing, increased light sensitivity, blurry
vision, discharge or swelling, should remove
their lenses and consult their eye care provider
immediately.

Confidentially: Distractions
can be dangerous

I was caring for a new patient, Mrs.
Walker, 27, who had Lyme disease. Her health care
provider prescribed high doses of I.V. penicillin,
so I prepared to start an I.V. infusion. I gathered
the equipment I'd need, then went into her room
to start the procedure.

After connecting the tubing to the solution bag,
I was interrupted by a physician who asked for
an update on another patient. When I got back
to Mrs. Walker, I inserted the catheter, connected
the tubing to it, then opened the I.V. line. Suddenly,
I realized that I'd forgotten to prime the tubing.
The air in it had entered my patient's bloodstream.

In a panic, I clamped off the tubing and turned
Mrs. Walker onto her left side. I called her provider
and a respiratory therapist. I connected a cardiac
monitor and started I.V. fluids properly. I was
concerned that the air could have caused an embolism,
but by some miracle, nothing happened.

Now I never stop a procedure in the middle and
try to pick up where I left off (unless the interruption
is an emergency). It's just too risky.

Take Note: Documenting oral
drug administration

After
administering a tablet or capsule, be sure to
record:

drug given

dose given

date and time of administration

signing out of the drug on the patient's
medication record

patient's ability to swallow the drug you
administered (if the patient has had problems
swallowing oral drugs)

patient's vital signs if you give a drug
that could affect them

adverse reactions that arise

patient's refusal and notification of a
health care provider as needed (if a patient
refuses a tablet or capsule)

Diarrhea commonly is divided into
two types, large volume and small volume, based
on the characteristics of the diarrheal stool.
Large-volume diarrhea results from an increase
in the water content of the stool, and small-volume
diarrhea results from an increase in the bowel's
propulsive activity. Some of the common causes
of small- and large-volume diarrhea are listed
below. Keep in mind that in many cases, diarrhea
is a combination of these two types.

Q:
While assessing the patency of a central line
for an unresponsive, terminally ill patient,
I was startled when the patient’s wife said
to me, "This isn't how it was supposed to be.
He's just a year away from retirement, and we
had wonderful plans to travel across the country."
I didn’'t know what to say except, "I'm sorry."
I'd like to do better if this situation comes
up again. What should I have said?—V.B., ARIZ.

A:
I think saying "I'm sorry" was just fine. It
showed that you heard the woman's grief and
validated her misfortune. Sometimes the only
thing to say is, "I don't know what to say,
but I do know I want to be here with you awhile."

Often patients or family members speak rhetorically,
not really expecting an answer. But they always
welcome "presence." And sometimes that's the
only thing you have to give. Take a few minutes,
sit down, and give your undivided attention.
Lean slightly toward her. Let your body language
tell her, “I truly want to hear your concerns."
Don't interrupt or change the subject. Don't
fidget or think ahead about questions you want
to ask. Just listen.

When she stops speaking, you may ask a question
related to her last words. Be sympathetic. Touch
her arm gently. Listen to her response. Forget
about how much of your precious time is being
taken. Choosing to give the gift of yourself
is always time well spent.

Don't miss Joy Ufema's
regular column, "Insights on Death and Dying,"
in Nursing2006. Check out her new book,
Insights on Death and Dying. Have
a question for Joy? You can e-mail it to her
here.

Ask a Colleague: Peptic ulcers

Q: How can I help my patient with a peptic
ulcer understand his disease?

A: Explain to your patient that a peptic
ulcer is an erosion of the stomach lining caused
by a bacterial infection called H. pylori.
A peptic ulcer may be located in the duodenum
of the small intestine or in the stomach. Regardless
of location, the ulcer develops in the same way.

Tell your patient that if the disease is to be
cured, the bacteria that caused the ulcer must
be removed. This is typically accomplished with
a drug regimen that usually includes a proton
pump inhibitor or bismuth and treatment with an
antibiotic such as amoxicillin or clarithromycin.
Advise him that he needs to take the drugs as
prescribed for treatment to be successful.

Mention that the gnawing, burning, or aching pain
in the epigastric area typically subsides when
food, milk, and antacids neutralize stomach acid.

Don't
simply memorize material. Instead, aim for understanding
the material. Remember that the NCLEX isn't designed
to test for memorization but rather for an understanding
of the concepts. When studying content, ask yourself,
"How can I use this information when I care for
clients?"

Don't miss these substantive, peer-reviewed
features in the November issue of Nursing2006.
They'll help you learn about evidence-based practice
and are FREE to access online at www.NursingCenter.com.

Managing symptoms for a "good death"
By Marylou Kocuh, APRN,BC, MSN
Your terminally ill patient is nearing death.
Do you know how to keep her comfortable? Here,
you'll learn how to manage common signs and
symptoms she's likely to experience.
Earn 2.5 ANCC/AACN contact hours

Understanding the 12-lead ECG, part I
By Guy Goldich RN, CCRN, MSN
Find out how the ECG translates the heart's
electrical activity into a waveform and what
it tells you about your patient's condition.
Earn 2.5 ANCC/AACN contact hours

Test Yourself: NCLEX practice
questions

Worried
about passing the National Council Licensure Examination
(NCLEX), the test from the National Council of
State Boards of Nursing (NCSBN) that your state
board of nursing will use to determine whether
you’re ready to practice nursing? The more practice
questions you do, the more confident you'll feel.
Try these, then review the answers and rationales
that follow. Experts recommend taking many practice
questions before the NCLEX, so take advantage
of review courses, books, and other products to
help you succeed and pass the NCLEX.

One of the new format questions you're likely
to see is called "sequencing." With these questions,
you need to put the possible answer choices
in priority order. Here are a few samples you
can practice on.

A community nurse is leading a discussion
with clients in a support group on the progressive
nature of multiple sclerosis (MS). Arrange
the degenerative changes shown below in the
order in which they occur.

degeneration of axons

demyelination throughout the central
nervous system

periodic and unpredictable exacerbations
and remissions

plaque formation that interrupts nerve
impulses

A nurse is preparing a staff-education
program about pulmonary circulation. Place
the options below in the order that matches
the path of pulmonary circulation.

pulmonary vein

right ventricle

pulmonary artery

arterioles

alveoli

left atrium

A client is diagnosed with herpes
zoster. Place the pathophysiologic changes
associated with this disorder in the proper
sequence.

Fever, malaise, and red nodules appear
in dermatome distribution.

The virus multiplies in the ganglia,
causing deep pain, itching, and paresthesia
or hyperesthesia.

Vesicles crust and scab but no longer
shed the virus.

Residual antibiotics from the initial
infection mobilize but are ineffective.

Vesicles appear filled with either clear
fluid or pus.

Varicella-zoster virus is reactivated.

A client is to get a blood transfusion
of packed red blood cells for severe anemia.
Place the following steps in the order a nurse
would follow to administer this product.

A nurse is caring for a client with
low calcium levels. Prioritize the regulation
of parathyroid hormone (PTH) release in relationship
to low calcium levels.

A high serum calcium level and inhibited
PTH secretion

A low serum calcium level

Resorption of calcium

PTH release by the parathyroid gland

Answers to NCLEX practice questions

2-1-4-3Rationale:
Multiple sclerosis produces patches of demyelination
throughout the central nervous system, resulting
in myelin loss from the axis cylinders and
degeneration of the axons. Plaques form in
the involved area and become sclerosed, interrupting
the flow of nerve impulses and resulting in
various symptoms. Periodic and unpredictable
exacerbations and remissions occur. The prognosis
varies.

2-3-4-5-1-6Rationale:
The blood leaves the right ventricle and travels
through the pulmonary arteries to the arterioles
of the lung. Carbon dioxide and oxygen are
exchanged where the pulmonary capillary interfaces
with the alveoli. The pulmonary vein carries
oxygenated blood back to the left atrium for
circulation throughout the body.

6-4-1-2-5-3Rationale:
Herpes zoster is an acute inflammation caused
by infection with the herpes virus varicella-zoster
(chickenpox virus). The pathophysiologic changes
associated with this disorder occur in the
order shown here.

4-6-2-5-1-3Rationale:
To administer a blood transfusion, the nurse
should follow the steps in the order listed
here. Note that the transfusion may be withheld
if the client's temperature is 100° F
or greater. The nurse must check two client
identifiers before the transfusion.

2-4-3-1Rationale:
Simple feedback occurs when the level of one
substance regulates the secretion of hormones.
A low calcium level stimulates the parathyroid
gland to release PTH, which promotes resorption
of calcium, resulting in normalized calcium
levels. When calcium levels are elevated,
PTH secretion is inhibited.

Subscribe to Nursing2006
and ANSfor
just $19.95—a 72%* savings for nursing
students.
* Savings off the annual single copy price
of $72. Nursing2006 is published
monthly year-round; ANS is published
bimonthly during the school year.

Nursing Made Incredibly Easy!
This journal makes learning effortless
and fun! Get a risk free subscription for just
$19.95 - 58%* savings for nursing students!

E-mail this Nursing2006 ANS eNews
to colleagues and invite them to become members
of NursingCenter by joining now.
They,
too, can sign up for their own issue of Nursing2006 ANS eNews
for great content as well as free articles,
tips, and more available only to subscribers.

Want to make sure
that you keep receiving Nursing2006 ANS eNews? Be sure
to add PE-ANS@wolterskluwer.com
to your address book!

NursingCenter respects
your privacy and will not share your information
with other companies or organizations without
your permission. View our Privacy Policy.

If you no longer
wish to receive Nursing2006 ANS eNews, update
your profile by following these simple steps: